PEPFAR is at a critical turning point in its decade-long existence. The next US Global AIDS Coordinator is uniquely positioned to set the course for the program’s future. A change in leadership at the President’s Emergency Plan for AIDS Relief creates an opportunity to ask questions about the organization and reflect in more general terms on the US response to the global AIDS epidemic.
The Global Fund is currently finalizing design and implementation of its New Funding Model (NFM), which includes a focus on strengthened measurement and an impact-based investment strategy.
This is the data set for Policy Paper 33 in which Victoria Fan, Denizhan Duran, Rachel Silverman, and Amanda Glassman
More than ever, global health funding agencies must get better value for money from their investment portfolios; to do so, each agency must know the interventions it supports and the sub-populations targeted by those interventions in each country. In this study we examine the interventions supported by two major international AIDS funders: the Global Fund to Fight AIDS, Tuberculosis, and Malaria (‘Global Fund’) and the President’s Emergency Plan for AIDS Relief (PEPFAR).
Afghanistan’s progress against mortality reflects the success of providing health aid that differed radically from the bulk of American aid to Afghanistan during the war. The USAID program that contributed to the decline was a multilateral effort coordinated by Afghanistan’s own Ministry of Public Health. Results were verified by random sampling, and some funding was linked to measures of performance. This internal policy experiment, however, was destined to provoke resistance. More surprising is the source of resistance to an aid program that attempted to stop simply throwing money at a problem and focus on building sustainable systems: auditors.
This report offers a strategy for the Global Fund to get more health for the money by focusing more on results, maximizing cost-effectiveness, and systematically measuring performance throughout its operations.
Performance-based financing can be used by global-health funding agencies to improve program performance and thus value for money. The Global Fund to Fight AIDS, Tuberculosis and Malaria was one of the first global-health funders to deploy a performance-based financing system. However, its complex, multistep system for calculating and paying on grant ratings has several components that are subjective and discretionary. We aimed to test the association between grant ratings and disbursements, an indication of the extent to which incentives for performance are transmitted to grant recipients.
This is the data set for Policy Paper 31, in which Victoria Fan, Denizhan Duran, Rachel Silverman, and Amanda Glassman analyze data on the Global Fund performance-based financing system to test the association between grant ratings and disbursements.
This is the data set for Policy Paper 27 , “The Financial Flows of PEPFAR: A Profile,” in which Victoria Fan, Rachel Silverman, Denizhan Duran, and Amanda Glassman track the financial flows of the President's Emergency Plan for AIDS Relief (PEPFAR) from donor agencies via intermed
Little is known about the President’s Emergency Plan for AIDS Relief (PEPFAR) financial flows within the United States (US) government, to its contractors, and to countries. We track the financial flows of PEPFAR – from donor agencies via intermediaries and finally to prime partners. We reviewed and analyzed publicly available government documents; a Center for Global Development dataset on 477 prime partners receiving PEPFAR funding in FY2008; and a cross-country dataset to predict PEPFAR outlays at the country level. We present patterns in Congressional appropriations to US government implementing agencies; the landscape of prime partners and contractors; and the allocation of PEPFAR funding by disease burden as a measure of country need.
When Is Prevention More Profitable than Cure? The Impact of Time-Varying Consumer Heterogeneity - Working Paper 334
We argue that in pharmaceutical markets, variation in the arrival time of consumer heterogeneity creates differences between a producer’s ability to extract consumer surplus with preventives and treatments, potentially distorting R&D decisions. If consumers vary only in disease risk, revenue from treatments—sold after the disease is contracted, when disease risk is no longer a source of private information—always exceeds revenue from preventives. The revenue ratio can be arbitrarily high for sufficiently skewed distributions of disease risk. Under some circumstances, heterogeneity in harm from a disease, learned after a disease is contracted, can lead revenue from a treatment to exceed revenue from a preventative. Calibrations suggest that skewness in the U.S. distribution of HIV risk would lead firms to earn only half the revenue from a vaccine as from a drug. Empirical tests are consistent with the predictions of the model that vaccines are less likely to be developed for diseases with substantial disease-risk heterogeneity
In just five years, India’s Rashtriya Swasthya Bima Yojana (RSBY, translated as “National Health Insurance Programme”) has expanded health-care access. Where dozens of “microinsurance” and NGO pilots failed to scale up, RSBY has already provided more than 110 million people (almost 10 percent of India’s population) with heavily subsidized health insurance, providing up to US$550 annually to finance secondary hospital care. Although the research evidence on RSBY is still developing, early results are encouraging: increased utilization and hospitalization; some indication of reduced out-of-pocket payments for healthcare; and a means of identification with a clearly linked entitlement. While RSBY still faces challenges, particularly on the quality of care of increased hospitalization rates, RSBY has aligned incentives for both public and private hospitals to deliver better care.
In this essay, Victoria Fan tells the story of how RSBY came into being under the leadership of Anil Swarup—whom she describes as an “unassuming officer of the Indian Administrative Service”—and outlines the program’s early successes and opportunities for future progress.
The authors carry out a systematic review of studies on CCTs that report maternal and newborn health outcomes, including studies from eight countries. We find that CCTs have increased antenatal visits, skilled attendance at birth, delivery at a health facility, and tetanus toxoid vaccination for mothers, and reduced the incidence of low birth weight. The programs have not had a significant impact on fertility or Caesarean sections while impact on maternal and newborn mortality has not been well documented thus far.
In this essay, Toby Ord explores the moral relevance of cost-effectiveness, a major tool for capturing the relationship between resources and outcomes, by illustrating what is lost in moral terms for global health when cost-effectiveness is ignored.
Given the vital importance of child vaccination programs to US national security interests, intelligence-community participation in public health services should be explicitly banned. Doing so might help restore confidence in vaccination programs—benefiting those immunized and the health and security of Americans here at home.